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Biomedical subjects

J L Berger

Publications and source records attributed to J L Berger.

11 recordsLinked to original sources

The influence of the SPEED bracket's self-ligating design on force levels in tooth movement: a comparative in vitro study.

In the SPEED bracket system the arch wire is retained in the arch wire slot by means of a built-in, escape-proof, flexible spring clip. Unlike the traditional edgewise bracket, it requires no ligature tie, thus ostensibly reducing the frictional force generated by the more-established elastomeric or steel-tie ligature systems. An in vitro study was designed to compare the level of force required to move four distinct arch wires a similar distance, on six occasions, through four ligated bracket systems and the self-ligated SPEED bracket. The results consistently demonstrated a significant decrease in the force level required for the SPEED bracket with all four arch wires when compared with elastomeric and steel-tie ligation in both metal and plastic bracket systems.

Dental Stress Analysis

[Recurrent nerve paralysis and Claude Bernard-Horner syndrome following an interscalene block of the brachial plexus].

The association of a recurrent laryngeal block with a Horner's syndrome occurred in one patient after right interscalene brachial plexus block. Hoarseness was the main clinical symptom of recurrent paralysis and lasted 4 h. The subsequent course was totally uneventful and required no specific treatment. But the interscalene route of brachial plexus block may be potentially hazardous in the patient with a full stomach.

Adult

[Brachial plexus block in children. Approach through the brachial canal].

This study included 35 children (average age: 8 years) undergoing surgery of the upper limb under brachial plexus block. The brachial plexus was approached by the brachial canal route, which is a simple, rapid and efficient way (34 were successful). The main advantage of this technique was the avoidance, in most children, of general anaesthesia as a complement. In addition, postoperative analgesia was satisfactory in all cases. In spite of large doses and volumes of lidocaine and bupivacaine used with this technique, no complication was observed.

Adolescent

[Is automatic oscillometric measurement of blood pressure reliable in hypotension?].

The reliability of an automatic oscillometric device for measurement of blood pressure (BP) was assessed in a large range of BP values during intraoperative normotension and induced hypotension. Direct BP measurements were carried out with a radial catheter. Data were compared with those obtained with the oscillometric device placed on the opposite arm. Nine patients were studied, undergoing 234 measurements of BP ranging from 55 to 208 mmHg (7.3 to 27.7 kPa) for systolic blood pressure (Pasys), from 32 to 130 mmHg (4.3 to 17.3 kPa) for diastolic blood pressure (Padia) and from 36 to 154 mmHg (4.8 to 20.5 kPa) for mean blood pressure (Pa). Good correlation between the two techniques was found for Pasys measurements recorded during both normotension and hypotension (r = 0.93; p less than 0.01). 92% of the values recorded with the oscillometric device were lower than those measured invasively. In the other cases (8% of the data), the mean difference between the two techniques was 5.5 mmHg (0.7 kPa). When BP values lower than 90 mmHg (12 kPa) for Pasys, 60 mmHg (8 kPa) for Padia and 70 mmHg (9,3 kPa) for Pa were considered individually, the correlation coefficients were 0.83, 0.73 and 0.77 respectively. These findings suggested that the oscillometric method can be considered as relatively suitable for monitoring moderate hypotension induced by vasodilators. The invasive technique must however remain the method of choice during profound hypotension.

Anesthesia, General

Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC 45) in patients with cirrhosis.

To evaluate the effect of liver cirrhosis on the pharmacokinetics and the pharmacodynamics of vecuronium, 12 patients with cirrhosis, aged (mean +/- SD) 52 +/- 12 yr, and 14 control patients, 42 +/- 15 yr, undergoing elective surgery under general anesthesia were studied. The simultaneous time courses of the plasma concentration of vecuronium and of the neuromuscular blockade were studied after the administration of a bolus dose of 0.2 mg X kg-1. Vecuronium plasma concentration declined biexponentially in both groups. Vecuronium plasma clearance was reduced significantly (P less than 0.01) from 4.26 +/- 1.38 ml X min-1 X kg-1 in the controls to 2.73 +/- 1.19 ml X min-1 X kg-1 in the patients with cirrhosis. The elimination half-life was 58 +/- 19 min in the controls and was prolonged significantly to 84 +/- 23 min (P less than 0.01) in the patients with cirrhosis. The total apparent volume of distribution was unchanged in patients with cirrhosis (0.253 +/- 0.086 1 X kg-1 vs. 0.246 +/- 0.092 1 X kg-1 in the controls). Cirrhosis caused a prolongation of the neuromuscular blockade induced by vecuronium: the duration of effect from injection to 50% recovery of the twitch height was prolonged by 100% (P less than 0.01) from 62 +/- 16 min in the controls to 130 +/- 52 min in patients with cirrhosis. The recovery rate (TH 25-75) also was prolonged (P less than 0.05) from 21 +/- 7 min in the controls to 44 +/- 18 min in patients with cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Feasibility of integration of modalities in melanomas and sarcomas.

Chemotherapy was administered in the immediate postoperative period to seventy patients (52 with melanomas and 18 with sarcomas) after a total of eighty-seven major operations, with no morbidity or mortality traceable to the chemotherapy. There was no apparent interference with wound healing or what would be considered a normal postoperative course. Fourteen of these patients (5 with melanomas and 9 with sarcomas) received a combination of radiation anc chemotherapy initiated in the postoperative period, and it was tolerated well. This combination appears to be safe, provided the field of radiation is not so large that is may add significantly to the myelosuppressive effect of chemotherapy and the dosage of concomitantly administered radiopotentiating agent(s) is reduced. Sixteen patients had Bacillus Calmette-Gúerin (BCG) immunotherapy in the immediate postoperative period without complications. This policy of a tight interweaving of modalities is safe, has the theoretic advantage of an earlier concerted attack on microscopic residual tumor, and appears particularly promising in sarcomas.

BCG Vaccine

[Endoluminal protection of colorectal anastomosis by Coloshield. Apropos of 14 cases].

Ideal exeresis with immediate anastomosis protected by an endoluminal shield (Coloshield) was performed in a series of 14 patients with left colic lesions for which the classical treatment would have been exeresis without anastomosis. No post-operative anastomotic fistulas were observed; one case of secondary stenosis of the anastomosis was treated successfully by endoscopic dilatation. The results of this series suggest that this technique is a reliable method of internal intestinal by-pass which offers real progress by allowing left colon exeresis with immediate anastomosis even in case with unfavourable local conditions.

Adult